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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 22100 Bruella Road CDy2e,Acampo/95220 v <br /> CROSS STREET LuballLn APN 01718008 <br /> PARCEL SIZE ` <br /> 0 <br /> OWNER NAME Christian WBISZ <br /> PHONE <br /> OWNER ADDRESS same as above CITY/STATE/LP <br /> CONTRACTOR West Coast Backhoe.Inc. PHONE 209-339-7394 <br /> CONTRACTOR ADDRESS 33 Maxwell Street CrrY/STATE/ZW Lodi,CA 95240 <br /> LICENSE Ll.C-42 ❑-C36 OTHER A NUMBER 851157 ExPIRATION DATE 9130121 <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 'I PERC TEST # BUILDING PERMIT#EP-1904764 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION :. REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT - OUT-0F-SERVICE SEPTIC SYSTEM ._ DESTRUCTION <br /> INSTALLATION WILL SERVE: 11 RESIDENCE ❑ COMMERCIAL Li OTHER <br /> NUMBER OF LWING UNITS: 1 NUMBER OF BEDROOMS:4 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFC CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> C3LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS Infiltrator #of LINES 1 LENGTH OF LINES 61' ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION fl PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ftDISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTYUNE ft <br /> El DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER 1 WIDTH 36" ft DEPTH 25' ft <br /> DISTANCE TO NEAREST WELL 100 ft FOUNDATION 10' It PROPERTY LINE t0 ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WIT SAN JOAOUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 46 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CAL (209)953-7697 <br /> SIGNED TITLE <br /> DATE <br /> RE SMF <br /> TT- <br /> CE�V�T <br /> qPR ?O <br /> NVOq QUA 20 <br /> CTy&F qR �NTy <br /> ENT <br /> DEPARTMENT USE ONLY <br /> Application Accepted CeWICaba Date 4/17/2020 Area 4/99 Employee ID# SK <br /> Final Inspection By �� Date. �O-W ❑ SPECIAL.PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS Addition of 1 bedroom.Going from 3 bedroom to 4 bedroom Existing tank Is 1600 gallons. Tier II. <br /> PES <br /> C Received ClAmount Date Permit] <br /> Code INFO B Cash Remitted Service Re uest# Invoice# Permit ID# <br /> 4210 115 3300 ' SR0081985 <br /> 42-01 <br /> 4/74/16 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> �•n,� /�y��f � J <br />